Raleigh Observer on Alternatives

[Guest guest]

[Pete posted this on the Addict-L list. I couldn't find a way to

locate it on the RO website in order to provide a link, so I am

posting it here]

The News and Observer (Raleigh, NC)

July 27, 2000 Thursday, FINAL EDITION

SECTION: DAY; Pg. E1

LENGTH: 2115 words

HEADLINE: Is AA the only way?

BYLINE: Joyce Hicks, STAFF WRITER

BODY:

In the early 1990s, Audrey Kishline became the poster person

for the controlled drinking movement. An admitted problem drinker

who found it difficult to abide by abstinence-based programs such

as Alcoholics Anonymous, Kishline reasoned that there must be

another way.

She did some research and concluded that the great majority of

people who had drinking problems weren't stone-cold alcoholics,

that alcoholism wasn't a disease and that people weren't

powerless over their drinking. Many people with drinking problems

could, with the right tools, learn to moderate their drinking.

In 1993, Kishline founded Moderation Management, a nationwide

self-help group that helps people cut down on drinking. She also

wrote a book titled " Moderate Drinking: The New Option for

Problem Drinkers. "

The notion that a person could moderate his drinking behavior

was controversial. Other programs existed for problem drinkers

who wanted to cut down on their consumption, but the debate

mushroomed with Kishline's book, her appearances on television

talk shows and her interviews in newsmagazines.

Seven years later, Kishline is back at the center of the

debate. Only this time she's on the other side. In March, the

43-year-old mother of two, after a night of binge drinking, got

into her truck and killed two people. Two months before, she had

announced that she was switching to an abstinence approach, that

she had joined AA. After pleading guilty to vehicular homicide,

she denounced Moderation Management altogether, saying it was

" nothing but alcoholics covering up their problem. "

Hon of the National Council on Alcoholism and Drug

Dependence is used to the debate. He says that every few years

someone comes along and says there's evidence that a problem

drinker or alcoholic can be taught to control his drinking.

" Unfortunately, what rarely happens is five to six years down

the line revisiting those individuals to see if they've been able

to keep their drinking at moderate levels, " Hon says. " Kishline

is a textbook example of where a moderate drinking approach

clearly didn't work. "

The debate is about more than whether a problem drinker can

drink in moderation. It's also about the very nature of

alcoholism - whether it's a disease or not, and whether a person

has the power to control his actions.

###

Treatment options:

Theresa Edmondson, a substance abuse counselor in Greenville,

has been working with problem drinkers for more than 20 years.

Many of them continue to drink.

As director of the DrinkWise program at East Carolina

University, Edmondson believes that not every problem drinker is

an alcoholic and that many can learn to moderate their drinking

without having to give it up. She likens the treatment issues of

problem drinkers to those of a diabetic.

" If you come in today and your blood sugar is high, there is

an array of treatment options that we would look at in treating

your high blood sugar - going to the dietitian and looking at

your diet, looking at exercise, putting you on medications or

insulin. "

But when alcoholism is treated as a disease, there are no

options; abstinence is the only choice. And while this may be the

case for some people, Edmondson says, " I go to where the client

is and try to bring them forward from there instead of taking

something they fundamentally don't believe and force them into

that. "

Her program, like Moderation Management, holds that many

problem drinkers can learn to identify and cope with feelings

that lead to excessive drinking, thus empowering them to quit or

lessen their consumption.

The approach is not for everyone, Edmondson says, and one of

the challenges is to distinguish between problem drinkers and

alcoholics and to intervene before that crossover occurs.

" Alcohol problems happen on a continuum, " she says. In

general, problem drinkers are defined as people who have had

problems because of drinking (DWI arrest, marital problems,

tardiness at work). But they usually don't drink steadily and

don't experience symptoms of withdrawal when they stop. A heavy

drinker could be the college student who drinks to the point of

getting sick on the weekends but keeps up his grades and other

activities.

By contrast, alcoholics exhibit at least three of the

following symptoms: tolerance, withdrawal, an inability to cut

down, sacrificing work, family or social events to drink, a

preoccupation with finding and drinking alcohol; or persistence

in drinking despite health-related problems.

According to a study by the Institute of Medicine, problem

drinkers account for about 20 percent - or about 40 million

people - of the U.S. population. Five percent of the U.S.

population would be considered alcohol dependent or alcoholic.

Dr. Frederick Glaser, a member of the Moderation Management

advisory board and an addiction specialist at ECU, points to

research showing that even brief intervention sessions with

problem drinkers make a difference. He cites a 1992 study by the

World Health Organization of 1,500 people in 14 countries and a

similar study in the United States two years ago. Both reported

that for the majority of patients, a brief counseling session in

which they were advised to stop drinking was effective in

reducing alcohol consumption.

Glaser says the data support what he and others concluded in a

report by the Institute of Medicine, which reviews scientific

data for the government, a decade ago: that the harmful effects

of alcohol could not be reduced significantly unless options

other than abstinence were available to people with only mild to

moderate alcohol problems. Glaser directed the Institute of

Medicine study.

" The idea that one type of program or one treatment goal is

suitable for everyone that has a problem with alcohol is simply

not tenable, " Glaser says. " This is a very diverse problem, and

different people are going to need different kinds of help with

that. "

###

'A progressive disease':

Hon of the National Council on Alcoholism and Drug

Dependence knows that treating alcohol abuse problems is

complicated. He sees this as all the more reason that any drinker

who recognizes a problem with alcohol and decides to get help

ought not to drink at all.

" The thing that everybody needs to understand is that

alcoholism is a progressive disease, " he says. " If we were able

to identify the point where a problem drinker crosses over into

an alcoholic, then we might be able to acknowledge that

moderation is one approach to be used. But until then, our

recommendation is that abstinence remains the safest and most

predictable course for treating an alcohol-related problem. "

For more than 60 years, alcohol treatment and support programs

in the United States have focused almost exclusively on

abstinence. Programs have traditionally fallen into one of two

camps: Alcoholics Anonymous, a spiritual based self-help group,

or a variety of other 12-step treatment programs that combine

counseling components along with AA attendance.

Many people find the 12-step approach effective. Bill, who

uses only his first name in his capacity as a national AA

spokesman, says abstinence " is a way of living that ensures that

we stop drinking and that we find a way to live that's full and

happy, and that's what most of us are interested in doing. " AA

lets the individual decide for himself whether he is an

alcoholic.

Not everyone finds help through AA. Some take offense to the

overtly religious overtones, the requirement that the drinker

admit powerlessness and turn his problems over to a higher power

than themselves.

" It's never been AA's premise that we're the answer to

everybody's difficulties, and people have found other ways to

deal with their problems, " Bill says. " We're not in any position

to really decide for anyone else whether they can use the AA

principles for their lives. "

He wouldn't comment on Kishline, because the organization

doesn't discuss its own members or outside issues or programs

such as Moderation Management.

###

SMART approach:

On a recent Wednesday night, nine men and women sit in a

circle on the second floor of a Raleigh office building. Hands

clasped and legs crossed, they take turns talking about their

struggles.

Only first names are used, but this isn't an AA meeting. There

will be no deep analysis of how they came to abuse alcohol, no

admission of flawed or diseased characters, no talk of

powerlessness or a higher power. No one so much as mentions the

word " alcoholic. " Instead, the weekly Self Management and

Recovery Training (SMART Recovery) meeting focuses on recent

struggles and anticipated encounters that might trigger a desire

to drink.

Tonight, Gregg, one of the group's two peer leaders, seems to

be struggling the most. A binge drinker for more than half his

life, Gregg, 40, came to the SMART program in 1996 after several

attempts at AA. After an arrest for DWI, he completed an

outpatient treatment program at the Recovery Partnership in

Raleigh and joined the SMART support group. He has managed to

stay sober for nearly four years, though there have been a few

brief lapses. But with the one-year anniversary of his divorce

coming up, he has experienced cravings for alcohol.

The group begins charting Gregg's feelings and reactions on a

board. His emotions seem largely a result of guilt about

splitting from his wife, they observe, and grief about not seeing

his kids as much as he would like to.

His peers assure him that his feelings are normal, that it's

OK to feel sad. Then they brainstorm how he can get more out of

his time with his kids and lessen his desire for alcohol.

After the meeting, Gregg compares AA and SMART.

" The idea that I was diseased and if I turned it over to a

higher power that I could be cured didn't make sense to me, " says

Gregg, who has never considered himself an alcoholic. " No other

disease can be cured that way. It left me feeling as if perhaps

there was something wrong with me because I couldn't get the AA

concept. "

But he connected with SMART. " It allowed me to take charge of

something I wanted to see changed in my life and make changes in

it, " he says.

Which is the whole point, says Andy Orr, program director of

the Recovery Partnership.

" What's been unfortunate is that the treatment communities out

there based on AA have told people that it was the only option,

and that they were doomed if they didn't work the 12 steps, " he

says. " The reality is that many, many people can't or don't or

won't relate to it. So this approach is much more humanistic and

affirms their ability to recognize problems in their lives, to

learn from their problems and correct their behavior. "

###

A final word:

When Audrey Kishline founded Moderation Management, her action

came from the notion that she had no choice but AA. She wanted an

option. The people who work with alcohol problems understand that

need.

" We are only about people getting help, " says Gregg, the SMART

Recovery peer leader. " I don't care if it's through our program

or a 12-step program or a combination of both. We just want to

see people find a way to stop doing whatever they're doing that

is causing them trouble in their lives. "

They also worry about blaming a program for Kishline's

actions.

" I know Audrey, " says Glaser, the ECU addiction specialist who

is on the advisory board for MM. " And I think the view of most

people involved is that this does not reflect on the cogency of

the program any more than people on AA who fall off the wagon

would indicate that AA is invalid. "

###

Alcohol treatment and support groups:

Abstinence-based Groups:

Alcoholics Anonymous: or www.aa.org

Rational Recovery: or

www.rational.org/recovery/

Smart Recovery: Raleigh: 782-6554; Chapel Hill: 408-0121 or

www.smartrecovery.org

Women for Sobriety: www.womenforsobriety.org

The Recovery Partnership:

Raleigh and Cary: 782-6554

Durham: 419-0229

Moderate Drinking Treatment Programs and Support:

Drinkwise at the Center for Alcohol and Drug Abuse Studies at

ECU: or www.med.ecu.edu/pharm/addictioninfo

Moderation Management: or www.moderation.org

Other resources:

National Council on Alcoholism and Drug Dependence Inc.: (212)

206-6770.

American Society of Addiction Medicine:

GRAPHIC: 2 c photos A member of a Self Management and Recovery

Training group in Raleigh talks about his life at a weekly meeting.

The

intensity shows in Bev's hands as she

tells her SMART group about a recent lapse. Staff Photos By Brad

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